2025 AHIP FINAL EXAM QUESTIONS
WITH VERIFIED ANSWERS
Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being successfully
treate d for that condition. However, she and her physicians feel that after her lengthy hospital stay,
she will nee d a month or two of nursing and rehabilitative care. What should you tell them about
Original Medicare's coverage of care in a skilled nursing facility? - correct answer-
Medicare will cover Mrs. Shield's skilled nursing services provided during the first 20 days of her stay,
afte r which she would have a copay until she has been in the facility for 100 Sdays.
Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from arthritis through
ma ssage therapy. She is concerned about whether or not Medicare will cover these items and services.
Wha t should you tell her? - correct answer-
Medicare does not cover massage therapy, or, in general, glasses or dentures.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park that
might be of assistance? - correct answer-
She should contact her state Medicaid agency to see if she qualifies for one of several programs that
can help with Medicare costs for which she is responsible.
Mr. Alonso receives some help paying for his two generic prescription drugs from his employer's retiree
c overage, but he wants to compare it to a Part D prescription drug plan. He asks you what costs he
would g enerally expect to encounter when enrolling into a standard Medicare Part D prescription
drugSplan. Wha t should you tell him? - correct answer-
He generally would pay a monthly premium, annual deductible, and per-prescription cost-sharing.
Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but it provides no drug
c overage. She would like to keep the coverage she has but replace her existing Medigap plan with one
that provides drugScoverage. What should you tell her? - correct answer-
Mrs. Gonzalez cannot purchase a Medigap plan that covers drugs, but she could keep her Medigap
policy and enroll in a Part D prescription drug Splan.
Mr. Davis is 52 years old and hasSrecently been diagnosed with end-
stage renal disease (ESRD) and will soon begin dialysis. He is wondering if he can obtain coverage under
Medicare. What should you tell him? - correct answer-He may sign-
up for Medicare at any time however coverage usually begins on the fourth month after dialysis
treatmen ts start.
,Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently reviewed her Medicare Sum
mary Notice (MSN) and disagrees with a determination that partially denied one of her claims for service
s. What advice would you give her? - correct answer-
Mrs. Duarte should file an appeal of this initial determination within 120 days of the date she received
th e MSN in the mail.
Mrs. Geisler's neighbor told her she should look at her Part D options during the annual Medicare
enrollm ent period because the features of Part D might have changed. Mrs. Geisler can't remember
whatSPart D i s so she called you to ask what her neighbor was talking about. What could you tell her? -
correct answer- Part D covers prescription drugs and she should look at her premiums, formulary, and
cost-
sharing among other factors to see if they have changed.
Mr. Rainey is experiencing paranoid delusions and his physician feels that he should be hospitalized.
Wha t should you tell Mr. Rainey (or his representative) about the length of an inpatient psychiatric
hospital sta y that Medicare will cover? - correct answer-
Medicare will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's entire lifetime.
Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided under
Origin al Medicare. What should you tell Mr. Xi that best describes the health coverage provided to
Medicare be neficiaries? - correct answer-Beneficiaries under Original Medicare have no cost-
sharing for most preventive services.
Mr. Singh would like drug coverage but doesSnot want to be enrolled in a Medicare Advantage plan.
What should you tell him? - correct answer-Mr. Singh can enroll in a stand-
alone prescription drug plan and continue to be covered for Part A and Part B services through Original
Fe e-for-Service Medicare.
Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed full time, and paid
taxe s during that entire period. She is concerned that she will not qualify for coverage under part A
because s he was not born in the United States. What should you tell her? - correct answer-
Most individuals who are citizens and age 65 or over are covered under Part A by virtue of having paid
Me dicare taxes while working, though some may be covered as a result of paying monthly premiums.
Mrs. Quinn recently turned 66 and decided after many years of work to retire and begin receiving Social
S ecurity benefits. Shortly thereafter Mrs. Quinn received a letter informing her that she had been
automat ically enrolled in Medicare Part B. She wants to understand what this means. What should you
tell Mrs. Q
, uinn? - correct answer-
Part B primarily covers physician services. She will be paying a monthly premium and, except for many
pr eventive and screening tests, generally will have 20% co-
payments for these services, in addition to an annual deductible.
Mr. Patel is in good health and is preparing a budget in anticipation of his retirement when he turns 66.
H e wants to understand the health care costs he might be exposed to under Medicare if he were to
require hospitalization because of an illness. In general terms, what could you tell him about his costs
for inpatie nt hospital services under Original Medicare? - correct answer-
Under Original Medicare, there is a single deductible amount due for the first 60 days of any inpatient
hos pital stay, after which it converts into a per-
day coinsurance amount through day 90. After day 90, he would pay a daily amount up to 60 days over
hi s lifetime, after which he would be responsible for all costs.
WhatSimpact, if any, have recent regulatory changes had on MedigapSplans? - correct answer-
The Part B deductible is no longer covered for individuals newly eligible for Medicare starting January 1,
2 020.
Mrs. Paterson is concerned about the deductibles and co-
payments associated with Original Medicare. What can you tell her about Medigap as an option to
addres s this concern? - correct answer-
Medigap plans do not cover Original Medicare benefits, but they coordinate with Original Medicare
cover age.
Mrs. Turner is comparing her employer's retiree insurance to Original Medicare and would like to know
w hich of the following services Original Medicare will cover if the appropriate criteria are met. What
could you tell her? - correct answer-Original Medicare covers ambulance services.
Ms. Brooks has aggressive cancer and would like to know if Medicare will cover hospice services in case
s he needs them. What should you tell her? - correct answer-
Medicare covers hospice services, and they will be available for her.
Mr. Diaz continued working with his company and wasSinsured under his employer's group plan until he
r eached age 68. He has heard that there is a premium penalty for those who did not sign up for Part B
whe n first eligible and wants to know how much he will have to pay. What should you tell him? -
correct answer-
Mr. Diaz will not pay any penalty because he had continuous coverage under his employer's plan.
WITH VERIFIED ANSWERS
Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being successfully
treate d for that condition. However, she and her physicians feel that after her lengthy hospital stay,
she will nee d a month or two of nursing and rehabilitative care. What should you tell them about
Original Medicare's coverage of care in a skilled nursing facility? - correct answer-
Medicare will cover Mrs. Shield's skilled nursing services provided during the first 20 days of her stay,
afte r which she would have a copay until she has been in the facility for 100 Sdays.
Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from arthritis through
ma ssage therapy. She is concerned about whether or not Medicare will cover these items and services.
Wha t should you tell her? - correct answer-
Medicare does not cover massage therapy, or, in general, glasses or dentures.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park that
might be of assistance? - correct answer-
She should contact her state Medicaid agency to see if she qualifies for one of several programs that
can help with Medicare costs for which she is responsible.
Mr. Alonso receives some help paying for his two generic prescription drugs from his employer's retiree
c overage, but he wants to compare it to a Part D prescription drug plan. He asks you what costs he
would g enerally expect to encounter when enrolling into a standard Medicare Part D prescription
drugSplan. Wha t should you tell him? - correct answer-
He generally would pay a monthly premium, annual deductible, and per-prescription cost-sharing.
Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but it provides no drug
c overage. She would like to keep the coverage she has but replace her existing Medigap plan with one
that provides drugScoverage. What should you tell her? - correct answer-
Mrs. Gonzalez cannot purchase a Medigap plan that covers drugs, but she could keep her Medigap
policy and enroll in a Part D prescription drug Splan.
Mr. Davis is 52 years old and hasSrecently been diagnosed with end-
stage renal disease (ESRD) and will soon begin dialysis. He is wondering if he can obtain coverage under
Medicare. What should you tell him? - correct answer-He may sign-
up for Medicare at any time however coverage usually begins on the fourth month after dialysis
treatmen ts start.
,Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently reviewed her Medicare Sum
mary Notice (MSN) and disagrees with a determination that partially denied one of her claims for service
s. What advice would you give her? - correct answer-
Mrs. Duarte should file an appeal of this initial determination within 120 days of the date she received
th e MSN in the mail.
Mrs. Geisler's neighbor told her she should look at her Part D options during the annual Medicare
enrollm ent period because the features of Part D might have changed. Mrs. Geisler can't remember
whatSPart D i s so she called you to ask what her neighbor was talking about. What could you tell her? -
correct answer- Part D covers prescription drugs and she should look at her premiums, formulary, and
cost-
sharing among other factors to see if they have changed.
Mr. Rainey is experiencing paranoid delusions and his physician feels that he should be hospitalized.
Wha t should you tell Mr. Rainey (or his representative) about the length of an inpatient psychiatric
hospital sta y that Medicare will cover? - correct answer-
Medicare will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's entire lifetime.
Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided under
Origin al Medicare. What should you tell Mr. Xi that best describes the health coverage provided to
Medicare be neficiaries? - correct answer-Beneficiaries under Original Medicare have no cost-
sharing for most preventive services.
Mr. Singh would like drug coverage but doesSnot want to be enrolled in a Medicare Advantage plan.
What should you tell him? - correct answer-Mr. Singh can enroll in a stand-
alone prescription drug plan and continue to be covered for Part A and Part B services through Original
Fe e-for-Service Medicare.
Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed full time, and paid
taxe s during that entire period. She is concerned that she will not qualify for coverage under part A
because s he was not born in the United States. What should you tell her? - correct answer-
Most individuals who are citizens and age 65 or over are covered under Part A by virtue of having paid
Me dicare taxes while working, though some may be covered as a result of paying monthly premiums.
Mrs. Quinn recently turned 66 and decided after many years of work to retire and begin receiving Social
S ecurity benefits. Shortly thereafter Mrs. Quinn received a letter informing her that she had been
automat ically enrolled in Medicare Part B. She wants to understand what this means. What should you
tell Mrs. Q
, uinn? - correct answer-
Part B primarily covers physician services. She will be paying a monthly premium and, except for many
pr eventive and screening tests, generally will have 20% co-
payments for these services, in addition to an annual deductible.
Mr. Patel is in good health and is preparing a budget in anticipation of his retirement when he turns 66.
H e wants to understand the health care costs he might be exposed to under Medicare if he were to
require hospitalization because of an illness. In general terms, what could you tell him about his costs
for inpatie nt hospital services under Original Medicare? - correct answer-
Under Original Medicare, there is a single deductible amount due for the first 60 days of any inpatient
hos pital stay, after which it converts into a per-
day coinsurance amount through day 90. After day 90, he would pay a daily amount up to 60 days over
hi s lifetime, after which he would be responsible for all costs.
WhatSimpact, if any, have recent regulatory changes had on MedigapSplans? - correct answer-
The Part B deductible is no longer covered for individuals newly eligible for Medicare starting January 1,
2 020.
Mrs. Paterson is concerned about the deductibles and co-
payments associated with Original Medicare. What can you tell her about Medigap as an option to
addres s this concern? - correct answer-
Medigap plans do not cover Original Medicare benefits, but they coordinate with Original Medicare
cover age.
Mrs. Turner is comparing her employer's retiree insurance to Original Medicare and would like to know
w hich of the following services Original Medicare will cover if the appropriate criteria are met. What
could you tell her? - correct answer-Original Medicare covers ambulance services.
Ms. Brooks has aggressive cancer and would like to know if Medicare will cover hospice services in case
s he needs them. What should you tell her? - correct answer-
Medicare covers hospice services, and they will be available for her.
Mr. Diaz continued working with his company and wasSinsured under his employer's group plan until he
r eached age 68. He has heard that there is a premium penalty for those who did not sign up for Part B
whe n first eligible and wants to know how much he will have to pay. What should you tell him? -
correct answer-
Mr. Diaz will not pay any penalty because he had continuous coverage under his employer's plan.
